本文選題：應(yīng)變率成像技術(shù)　切入點(diǎn)：慢性腎臟病　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.應(yīng)用應(yīng)變率成像技術(shù)(Strain Rate Imaging,SRI)評(píng)價(jià)慢性腎臟病(Chronic Kidney Disease,CKD)各期左房功能的受損情況。2.了解慢性腎臟病各期進(jìn)展過程中,左房功能受損程度的變化情況。3.探討應(yīng)變率成像技術(shù)對(duì)不同分期CKD患者左房功能評(píng)價(jià)的應(yīng)用價(jià)值。方法:選取我院2016年4月~2016年10月腎內(nèi)科CKD患者58例,依據(jù)2012年全球腎臟病組織KDIGO所定義的標(biāo)準(zhǔn)納入,根據(jù)腎小球?yàn)V過率(GFR)水平將CKD患者分為3組,A組(19例,GFR≥60 ml/min/1.73m2,CKD 1~2期),B組(22例,GFR:30~59 ml/min/1.73m2,CKD 3期),C組(17例,GFR:15~29ml/min/1.73m2,CKD 4期),三組LVEF均大于55%,未進(jìn)行過透析治療;同時(shí)選取健康對(duì)照組(N組)19例,四組間性別、年齡無統(tǒng)計(jì)學(xué)差異。所有的受檢者采用Philips i E33彩色超聲診斷儀進(jìn)行檢查,分別采集連續(xù)3個(gè)心動(dòng)周期常規(guī)條件下及組織多普勒條件下心尖二腔切面及心尖四腔切面圖像,動(dòng)態(tài)儲(chǔ)存后進(jìn)行脫機(jī)分析。用simpson雙平面法測(cè)量左心房最大容積LAVmax、最小容積LAVmin、主動(dòng)收縮前容積LAVp,通過這幾個(gè)參數(shù)值計(jì)算左心房的被動(dòng)射血容積LAPEV=LAVmax-LAVp、左心房的主動(dòng)射血容積LAAEV=LAVp-LAVmin、左心房的被動(dòng)射血分?jǐn)?shù)LAPEF=LAPEV/LAVmax、左心房的主動(dòng)射血分?jǐn)?shù)LAAEF=LAAEV/LAVp,左心房的總射血分?jǐn)?shù)LATEF=(LAVmax-LAVmin)/LAVmax。運(yùn)用QLAB-SQ軟件得出左心房前壁、下壁、側(cè)壁及房間隔共4個(gè)節(jié)段心肌應(yīng)變率曲線,分別測(cè)量各個(gè)壁收縮期、舒張?jiān)缙诩笆鎻埻砥谄骄鶓?yīng)變率峰值SRs、SRe及SRa。上述測(cè)值均連續(xù)測(cè)量3次,取平均值。結(jié)果:1.常規(guī)二維參數(shù)比較B組、C組LAVmax、LAVmin、LAVp較N組、A組增大(P0.05),即CKD 3期、4期患者左心房容積增大;B組、C組LATEF、LAPEF較N組、A組減少(P0.05),即CKD 3期、4期患者左心房?jī)?chǔ)存功能及管道功能減低;2.應(yīng)變率參數(shù)比較SRs、SRe:B組、C組前壁、下壁、側(cè)壁及房間隔較N組、A組均降低(P0.05),結(jié)果同上,CKD3期、4期時(shí)左心房?jī)?chǔ)存功能及管道功能受損,其中B組與C組無明顯統(tǒng)計(jì)學(xué)差異(P0.05),說明CKD患者病情從3期進(jìn)展到4期時(shí),左房的儲(chǔ)存功能及管道功能未明顯進(jìn)一步受損;SRa:四組間前壁、下壁、側(cè)壁及房間隔無顯著性差異(P0.05),表明慢性腎臟病前4期患者左房的助力泵功能未受損。3.應(yīng)變率SRe/a比較SRe/a可定位反應(yīng)左心房的舒張功能,整體B組、C組SRe/a較正常組及A組減低,且有統(tǒng)計(jì)學(xué)差異(P0.05);且C組前壁及下壁SRe/a較B組進(jìn)一步較低(P0.05),說明CKD3、4期患者左房舒張功能減低,受損心肌以前壁和下壁為著。結(jié)論:本次研究,SRI測(cè)量結(jié)果同常規(guī)參數(shù)測(cè)量結(jié)果提示一致,但SRI測(cè)量更為簡(jiǎn)便、準(zhǔn)確,能評(píng)價(jià)不同分期慢性腎臟病患者左房的功能,并可以評(píng)估左房功能的受損程度,從而可以為臨床早期干預(yù)提供依據(jù)。
[Abstract]:Purpose 1.Strain Rate imaging (SRI) was used to evaluate the impairment of left atrial function in patients with chronic kidney disease (Chronic Kidney diseaseCKD).To understand the changes of left atrial function damage in each stage of chronic kidney disease.To evaluate the value of strain rate imaging in evaluating left atrial function in patients with CKD at different stages.Methods: 58 patients with CKD from April 2016 to October 2016 in our hospital were selected and included according to the criteria defined by the global kidney disease tissue KDIGO in 2012.There was no statistical difference in sex and age among the four groups.All the subjects were examined by Philips I E33 color ultrasound diagnostic instrument. The images of apical two-chamber section and apical four-chamber section were collected under the conventional condition of 3 consecutive cardiac cycles and under the condition of tissue Doppler respectively, and then the off-line analysis was performed after dynamic storage.The active ejection fraction of left atrium was LAAEFV / LAAEV / LAVp, and the total ejection fraction of left atrium was LAVmax-LAVminn / LAVmax.The strain rate curves of left atrial anterior wall, inferior wall, lateral wall and atrial septum were obtained by QLAB-SQ software.The above measured values were measured continuously for 3 times, and the average values were taken.The result is 1: 1.Comparison of two dimensional parameters between group B and group C the left atrial volume of patients with stage 3 and stage 4 of CKD was increased, and the left atrial volume in group B was lower than that in group N (P 0.05), that is, the storage function and conduit function of left atrium in patients with stage 3 and stage 4 of CKD were decreased by 2. 05%.The strain rate parameters of group C were compared with those of group C. The anterior wall, inferior wall, lateral wall and atrial septum of group C were lower than those of group N (P 0.05). The results showed that the left atrium storage function and conduit function were impaired in stage 4 of CKD3.There was no significant difference between group B and group C (P 0.05), which indicated that the storage function and conduit function of left atrium were not further damaged in patients with CKD from stage 3 to stage 4.There was no significant difference in lateral wall and atrial septum (P 0.05), indicating that the left atrial pump function was not impaired in the first four stages of chronic kidney disease.Strain rate SRe/a compared with SRe/a could localize the diastolic function of left atrium. SRe/a in group B and C was lower than that in group A and normal group.The SRe/a of anterior wall and inferior wall in group C was lower than that in group B, indicating that left atrial diastolic function was decreased in patients with CKD3 stage 4, and the anterior wall and inferior wall of myocardium were damaged.Conclusion: the results of Sri measurement in this study are consistent with those of conventional parameter measurement, but SRI measurement is more convenient and accurate. It can evaluate the left atrial function of patients with chronic kidney disease at different stages, and can evaluate the degree of damage to left atrial function.Therefore, it can provide basis for early clinical intervention.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692;R540.4

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